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Chou was born aboard a Starfleet transport ship. On the day of her birth, the ship came under fire from Hirogen hunters. Baby and mother escaped, but her father died in the attack. Chou's mother suffered serious injury and died sometime later aboard the vessel that responded to their distress call. As her next of kin couldn’t be located, Chou was put into a Starfleet orphanage for children whose parents had died in action. This orphanage was located in a region of Earth known as Canada.

On Chou’s nineteenth birthday she applied to Starfleet Academy to become a tactical officer. During a training mission in her final year she was marooned on a Class L planet with her fellow cadets; their shuttle was hit by debris from a passing comet. A dying Vulcan cadet made an atypical Vulcan comment about the logic behind the event: Chou survives tragedies while those around her die. This comment stuck with her and as soon as she got back to the Academy she transferred to Starfleet Medical with the intent of saving those hurt by her poor luck.

Chou was posted to Mariner by request of Rear Admiral Bryant, against the wishes of Jenan Gage the ship’s captain. Bryant was wary of Gage’s history and wanted Chou to keep an eye on him ("Shakedown"). She serves as the chief medical officer.

Before he was joined, Gage was a mentor to Chou and other cadets, supervising basic missions early in her career at the Academy. The two became especially close, but Gage wasn’t satisfied with the direction his career was going so he left both Starfleet and Chou to return home to Trill. By the time Chou was assigned to Mariner years later, they had both changed dramatically and their was always uneasy tension between them. Chou would go out of her way to emphasize her professional role when interacting with Gage, presumably to keep their working relationship in check. ("Shakedown")